Definition: It is displacement of the thin wall within the nose that separates the nasal cavity away from the midline. As septum deviation is very common (about 80%), the term "Deviated Septum" refers only to severely displaced nasal septums.
It may be due to excessive development of one plate of vomer more than the other, excessive development of turbinate pushing septum or high arched palate.
Intrauterine, birth trauma (common), or accidental.
Incidence: very common but usually not severe to cause symptoms.
- C shaped deviation.
- S shaped deviation.
- Spur: sharp angulation at the junction between cartilage and bone.
- Dislocation: lower border projects into nostril.
Symptoms of deviated septum:
- Nasal obstruction unilateral or bilateral.
- Epistaxis: Convex side vessels angulated. Concave side atrophic changes (dry friable mucosa).
- Neuralgia & headache: Contact (anterior ethmoidal nerve compression). Vacuum (fronto-nasal duct obstruction).
- Recurrent sinusitis.
- External nasal deformity.
Signs of deviated septum:
- Septal deviation, spur, or dislocation.
- Compensatory turbinate hypertrophy.
- Endoscopic examination.
- CT, if sinusitis is suspected.
- Rhinomanometry & acoustic rhinometry (objective tests).
Treatment of deviated septum:
Surgical correction, indicated in symptomatic cases.
- Sub mucous resection (SMR)
- Septoplasty indicated when SMR is not useful: children, and septal dislocation.
NB: during surgery for septal correction: treat sinusitis if present by ESS, reduce size of inferior turbinate if large.